高效液相色谱——紫外、荧光双检测器同时测定人尿中犬尿氨酸和犬尿喹啉酸

目的建立高效液相色谱（HPLC）同时测定人尿中犬尿氨酸（KYN）和犬尿喹啉酸（KYNA）方法。用KYNA／KYN比值评价人体犬尿氨酸氨基转移酶（KAT）活性。方法采用HPLC测定KYN、KYNA,分析柱为安捷伦HCC18反相色谱柱;流动相为10mmol／L乙酸钠-乙酸缓冲液：7％乙腈=93：7;流速1mL／min;检测器波长：紫外365nm,荧光344nm（激发）／398nm（发射）。结果KYN和KYNA保留时间分别为6．9和11．5min。水溶液标准与标准加入工作曲线斜率差异无统计学意义（KYN：P=0．4068;KYNA：P=0．6462）。KYN和KYNA的平均回收率分别为98．74％±7．53％、95．17％±8．17％;稳定性试验的变异系数（CV）分别为3．35％和0．88％;精密度CV分别为2．73％和2．79％;最低检测限分别为0．4和0．2μmol／L。30份健康成年人尿样的KYNA／KYN比值为2．45±1．54。尿中KYNA与KYN含量呈正相关关系（r2=0．3758,P〈0．001）。结论测定方法灵敏、准确、稳定。KYNA／KYN比值评测KAT活性具有简便、实用等特点,可用于相关疾病的临床辅助诊断和基础研究。     

原发性高血压患者血浆色氨酸、犬尿氨酸和犬尿喹啉酸浓度的变化

目的通过测定血浆色氨酸(TRP)、犬尿氨酸(KYN)和犬尿喹啉酸(KYNA)浓度,探讨外周吲哚胺2,3-双加氧酶(IDO)和犬尿氨酸氨基转移酶(KAT)活性与原发性高血压(EH)的关系。方法采用高效液相色谱法(HPLC)测定100例EH患者和80名健康体检者(对照组)血浆TRP、KYN和KYNA浓度,计算产物/底物的百分比来评价酶活性,即IDO活性=KYN/TRP×100%,KAT活性=KYNA/KYN×100%。结果 EH组血浆TRP浓度为(59.85±9.89)μmol/L,明显高于对照组[(48.19±7.72)μmol/L,P<0.001];KYN浓度为(2.01±0.48)μmol/L,明显低于对照组[(2.17±0.43)μmol/L,P<0.05]。EH组和对照组血浆KYNA浓度分别为(24.10±9.12)、(23.59±7.27)μmol/L,二者差异无统计学意义(P>0.05)。EH组IDO活性为3.40%±0.85%,明显低于对照组(4.54%±0.81%,P<0.001);而KAT活性为1.20%±0.36%,明显高于对照组(1.09%±0.27%,P<0.05)。EH组血浆TRP浓度与年龄呈负相关(r=-0.316,P=0.001),而对照组二者之间无明显相关性(r=-0.208,P=0.064)。EH组和对照组血浆IDO活性均与年龄呈正相关(EH组:r=0.264,P=0.008;对照组:r=0.305,P=0.006)。2组血浆KYN、KYNA浓度及KAT活性与年龄均无明显相关性。结论EH组血浆TRP浓度明显增高而KYN浓度明显降低,提示外周TRP-KYN代谢途径的IDO活性可能与EH有关。     

高效液相色谱-荧光法测定血清犬尿喹啉酸和色氨酸方法的建立

目的建立同时检测血清犬尿喹啉酸（kynurenic acid，KYNA）和色氨酸（tryptophan，Trp）的高效液相色谱-荧光法。方法采用高效液相色谱在线衍生技术，通过对最佳检测波长、流速、流动相中醋酸锌浓度和乙腈比例等因素的探讨，得出测定Trp和KYNA的最优实验方案，并对其进行方法学评价；测定50名正常人血清KYNA和Trp含量。结果KYNA保留时间约为8．1min，线性范围为1．05～2093nmoL／L，最低检出浓度为0．05nmoL／L，平均回收率为101．19％；Trp保留时间约为11．3min，线性范围为0．49～196μmoL／L，最低检出浓度为0．001μmoL／L，平均回收率为104．43％，二者日内、日间测定的变异系数均小于5％，苯丙氨酸、酪氨酸、5-羟色胺和犬尿氨酸等物质对该法均无干扰。健康成人血清KYNA和Trp含量分别为（24．25±9．11）nmol／L和（49．05±11．67）μmol／L。结论建立的方法简便、快速、稳定、可行，适用于临床和科研工作。     

肠易激综合征患者肠道气体的研究

目的:通过X线腹部平片对肠道气体进行定量分析,探讨肠易激综合征(IBS)患者肠道气体量的变化。方法:根据罗马Ⅲ诊断标准选取IBS患者49例(便秘型25例和腹泻型24例),健康对照者25例,在空腹状态下摄立位腹部平片,扫描进入计算机,用图像处理软件(Photoshop 7.0)处理照片,在双肋弓外缘垂直线相交于膈顶水平线、耻骨联合上缘水平线形成的矩形框内,标出肠道内气体范围,分别计算整个矩形框及肠气范围的像素值,最后结果用气体容积积分表达(gas volume score,GVS),即肠气范围像素值与矩形框像素值之比。结果:IBS患者的GVS与健康对照组比较无明显差异(0.064±0.035vs0.055±0.043);便秘型IBS患者的GVS明显大于腹泻型IBS患者(0.077±0.040vs0.051±0.025,P<0.01)及健康对照组(0.077±0.040vs0.055±0.043,P<0.05),而腹泻型IBS患者的GVS与对照组相比无差异(0.051±0.025vs0.055±0.043,P>0.05)。结论:IBS患者肠道气体的量存在变化,且与IBS分型有关,便秘型IBS患者肠道气体增多,腹泻...     

184例肠道易激综合征肠外表现临床分析

肠道易激综合征(IBS irritable bowel syndrome)曾被称为结肠痉挛、结肠神经官能症,概指一组包括腹泻、腹痛、腹胀、便秘病程可达数年但又无明显病理改变和生化学异常的症候群,根据临床表现可分为腹泻型,便秘型及二者交替型(泻秘型),目前认为系心身疾病,病因与精神因素有关。本病不仅表现于结肠运动和分泌功能障碍,部分患者的上消化道、胆道甚至直肠肛门均可     

肠易激综合征发病机制的研究进展

肠易激综合征(Irritablebowelsyndrome,IBS)是腹部不适或腹痛伴排便异常的一组肠功能障碍综合征,无任何器质性或异常的生化指标。根据症状分为腹泻型、便秘型和腹泻便秘交替型。IBS是最常见的消化系疾病之一,西方国家有15%～20%的人患有IBS,我国潘国宗等近年用整群、随机抽样的方法进行的流行病学调查表明,有IBS症状者占北京地区人群的1%;广州魏秀清等用类似的方法调查表明有IBS症状者占该地区人群的5.6%。由于IBS的发病率呈逐年增多趋势,因而日益引起人们的重视。但IBS的病因和发病机制迄今还不完全清楚,其治疗也限于对症处理。若…     

肠易激综合征

肠易激综合征李定国作者单位：２０００９２上海第二医科大学附属新华医院虽然肠易激综合征（ＩＢＳ）的精确定义尚不明了，但它的含义是一种消化道功能紊乱。其特征为腹部不适，轻度至明显的腹痛；大便习惯改变，便秘和腹泻交替。ＩＢＳ因无解剖或代谢异常可与其他疾病鉴...     

肠易激综合征发病的内分泌机制

肠易激综合征 (ｉｒｒｉｔａｂｌｅｂｏｗｅｌｓｙｎｄｒｏｍｅ ,ＩＢＳ)是一种以肠平滑肌功能紊乱为主要表现的全身多因素疾病 ,发病率高 ,发病机制至今不清 ,诊断缺乏客观标志。作为一种调节肽 ,胃肠激素和其他内分泌因素在ＩＢＳ发病机制中的作用 ,逐渐受到关注。1　胃肠激素概念的演变自 190 2年 ,第一种人类胃肠激素促胰液素被发现以来 ,虽已近百年 ,但仅仅在近 10年余 ,由于细胞、分子生物学的发展 ,其研究才得以迅速开展 ,并逐步更新了传统的胃肠激素概念。1.1　胃肠激素概念的更新　胃肠激素的传统概念已不能概括胃肠道所产生的全部…     

肠易激综合征

肠易激综合征(IBS)是一种常见病,据估计占胃肠病门诊的20％～50％。该病女性多见,女男发病率之比为2～3:1,好发年龄为20～40岁。 1 病理生理学 IBS的发病机制迄今仍不明了。其机制可能涉及到胃肠动力和内脏感觉的改变。大量的研究证实,IBS患者的结肠、直肠和小肠均存在动力异常。IBS的典型症状大多由结肠动力     

肠易激综合征发病机制的研究进展

<正>肠易激综合征(IBS)是临床常见的慢性胃肠功能紊乱性疾病,以不定部位的腹痛、腹胀,或伴排便习惯和大便性状异常为特征。该病症状处于持续或间歇发作状态,且经相关检查无器质性病变。研究表明[1-2],1997年北京地区IBS流行率在7%左右,而在西方国家,成年人中IBS发病率约为8%~23%。该病病程较长,且反复发作,大     

Irritable Bowel Syndrome

ABSTRACT

Questions from patients about analgesic pharmacotherapy and responses from the authors are presented to help educate patient sand make them more effective self-advocates. The topics addressed in this issue are the signs, symptoms, and treatment of irritable bowel syndrome (IBS). A discussion of pain management and complementary therapies is included.     

The Irritable Bowel Syndrome

A discussion of functional bowel disturbances is presented, using the term irritable bowel syndrome. Etiologic factors are discussed and a useful classification is proposed. The diagnosis of the irritable bowel syndrome must be made by exclusion as well as by positive features, because identical symptoms are often produced by organic lesions. Psychotherapy and diet, as well as medication, are discussed in connection with treatment.     

肠易激综合征的诊断标准

肠易激综合征(irritable bowel syndrome, IBS)是临床上最为常见的胃肠功能紊乱性疾病,主要临床特征是腹痛和排便习惯改变.各地IBS发病率的统计资料不尽相同,约在3%～20%[1].IBS的发病机理迄今尚未完全阐明,由于其症状缺乏特异性,长期以来,IBS的诊断是一种排除性的诊断.在Manning标准之前,如何正确诊断IBS,一直是临床医师面临的难题.Manning标准开创了以症状为基础诊断IBS的先河,随后,又诞生了Kruis标准、Drossman标准、罗马标准,以及最近的罗马Ⅱ标准.     

Mechanism-Oriented Therapy of Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is a common and well-accepted diagnosis but often imprecisely applied to patients in usual clinical practice. Diagnosis is entirely based on symptom criteria that tend to include broad strata of abdominal complainers. Established criteria for diagnosis are strictly followed in controlled clinical trials for new therapeutic agents, but physicians are more lax in the clinic. Predictably, in light of the above ambiguities, many pathogenetic mechanisms and pathophysiological disturbances appear to be involved in IBS, but so far no mechanism-based subgroupings to guide specific therapy have been soundly established. Thus, diverse therapeutic approaches coexist and are discretionally prescribed by attending clinicians on the basis of major manifestations (i.e., diarrhea-predominance or constipation-predominance), more or less apparent psychological disturbances, and patient preferences (pharmacological versus dietary or microbiological approaches). In this review, we have attempted to update scientific knowledge about the more relevant disease mechanisms involved and relate this more fundamental basis to the various treatment options available today.     

肠易激综合征的发病机制研究现状

肠易激综合征(irritable bowel syndrome,IBS)是反复发作的腹痛或不适,最近3个月内每个月至少有3d出现症状,合并以下2条或多条:(1)排便后症状缓解。(2)发作时伴有排便频率改变。(3)发作时伴有大便性状(外观)改变。诊断前症状出现至少6个月,近3个月满足以上标准。不适意味着感觉     

Item-Level Assessment of the Irritable Bowel Syndrome Quality of Life Questionnaire in Patients With Diarrheal Irritable Bowel Syndrome

Background

In previous studies, the Irritable Bowel Syndrome Quality of Life (IBS-QOL) instrument has been determined to have good measurement properties for general irritable bowel syndrome (IBS) and the diarrheal IBS (IBS-d) subtype in clinical trials.

Objective

This article aims to extend the true-score analyses that have been previously conducted to evaluate the IBS-QOL in IBS-d patients.

Methods

Item response theory analysis was conducted by fitting models to responses from 753 patients with severe IBS-d from a recent clinical trial. Three item response theory models, the constrained graded response model (CGRM), the unconstrained GRM (UGRM), and the testlet response model (TRM), were fit to the 34 items of the IBS-QOL questionnaire. Subsequently, differential item functioning (DIF) for patient sex was assessed by fitting nested models by applying likelihood ratio tests. Model latent trait estimates were then compared with the IBS-QOL score and the IBS Symptom Severity Score.

Results

Model fits improved with complexity, with the TRM model fitting best compared with the CGRM and UGRM. The DIF evaluation for patient sex flagged 17 items for the CGRM and 9 items for the UGRM; however, these items were not found to have much effect on the overall estimation of the latent trait. Differential testlet functioning was not indicated, and no items exhibited potential DIF under the TRM because likelihood ratio tests were not statistically significant. Comparison of latent trait estimates to the IBS Symptom Severity Score and IBS-QOL questionnaire revealed high Spearman correlations (0.47 and ≥0.99, respectively).

Conclusion

Previous true-score approach results were supported by the IBS-QOL item-level analysis. Further, the IBS-QOL total score was found to be a valid measure of perceived quality of life for IBS-d patients when compared with more sophisticated model-based estimates of perceived quality of life. ClinicalTrials.gov identifier: NCT01130272.     

Management Options for Irritable Bowel Syndrome

Irritable bowel syndrome (IBS) is associated with diverse pathophysiologic mechanisms. These mechanisms include increased abnormal colonic motility or transit, intestinal or colorectal sensation, increased colonic bile acid concentration, and superficial colonic mucosal inflammation, as well as epithelial barrier dysfunction, neurohormonal up-regulation, and activation of secretory processes in the epithelial layer. Novel approaches to treatment include lifestyle modification, changes in diet, probiotics, and pharmacotherapy directed to the motility, sensation, and intraluminal milieu of patients with IBS. Despite recent advances, there is a need for development of new treatments to relieve pain in IBS without deleterious central or other adverse effects.     

IBS-QOL专用量表在肠易激综合征患者中的运用

目的评价Patrick等编制的IBS-QOL专用量表在中国肠易激综合征(irritable bowel syndrome,IBS)患者中的信度和效度.方法通过自填方式调查消化科门诊123例IBS患者.信度采用折半信度及内部一致性分析,效度采用维度相关分析及结构效度分析.结果本研究中量表折半信度γ=0.86,内部一致性除躯体意念、挑食外,其余各领域的克朗巴赫系数α在0.71～0.89之间;维度相关性分析,除行为障碍外,其他各维度中相关系数基本在0.60以上,各纬度中的条目得分与其它维度无关.因子分析,在载荷系数0.5的水准上选出8个主成分,与理论结构基本一致,结构效度累计贡献率达72.7%.结论 IBS-QOL专用量表有较好的效度及信度,可试用于国人IBS患者生命质量的测评.